Journal
HUMAN REPRODUCTION UPDATE
Volume 17, Issue 4, Pages 558-574Publisher
OXFORD UNIV PRESS
DOI: 10.1093/humupd/dmr005
Keywords
secondary recurrent miscarriage; H-Y antigen; pregnancy outcome; parity; pregnancy complications
Categories
Funding
- University Hospital Copenhagen Rigshospitalet
Ask authors/readers for more resources
background: Approximately half recurrent miscarriage (RM) cases remain unexplained after standard investigations. Secondary RM (SRM) is, in contrast to primary RM, preceded by a birth, which increases the transfer of fetal cells into the maternal circulation. Mothers of boys are often immunized against male-specific minor histocompatibility (H-Y) antigens, and H-Y immunity can cause graft-versus-host disease after stem-cell transplantation. We proposed the H-Y hypothesis that aberrant H-Y immunity is a causal factor for SRM. methods: This is a critical review of the H-Y hypothesis based on own publications and papers identified by systematic PubMed and EMBASE searches. results: SRM is more common after the birth of a boy and the subsequent live birth rate is reduced for SRM patients with a firstborn boy. The male: female ratio of children born prior and subsequent to SRM is 1.49 and 0.76 respectively. Maternal carriage of HLA-class II alleles presenting H-Y antigens to immune cells is associated with a reduced live birth rate and increased risk of obstetric complications in surviving pregnancies in SRM patients with a firstborn boy. In early pregnancy, both antibodies against HLA and H-Y antigens are increased in SRM patients compared with controls. Presence of these antibodies in early pregnancy is associated with a lower live birth rate and a low male: female ratio in subsequent live births, respectively. Births of boys are also associated with subsequent obstetric complications in the background population. conclusions: Epidemiological, immunogenetic and immunological studies support the hypothesis that aberrant maternal H-Y immune responses have a pathogenic role in SRM.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available